Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 152032 | NY |
NPI | 1316027212 |
---|---|
Provider Name | Pierre Carousse Jean Felix |
First Address | Brooklyn, NY 11236-4131 |
Second Address | Brooklyn, NY 11206-5317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00783459 | (05) | NY |
B13809 | (02) | NY |